POS0577 COMPARISON OF THE WHO AND ACC/AHA CARDIOVASCULAR ALGORITHMS TO DETECT CAROTID PLAQUE IN RHEUMATOID ARTHRITIS
Authors: N. Guajardo-Jauregui, D. Á. Galarza-Delgado, J. R. Azpiri-López, I. J. Colunga-Pedraza, A. Cárdenas, A. N. Garza-Cisneros, A. Garcia-Heredia, M. A. Balderas-Palacios, A. B. Rodriguez-Romero
Journal: Annals of the Rheumatic Diseases (2022)

Background Cardiovascular disease is the major cause of death in rheumatoid arthritis (RA) patients. Cardiovascular risk algorithms are used to estimate the probability for the development of a cardiovascular event in 10 years, according to patients’ characteristics, however, no algorithm existed for the Hispanic population until the World Health Organization (WHO) published the cardiovascular disease risk charts for 21 regions (1). Objectives To compare the capacity of the 2019 WHO algorithm and the 2013 American College of Cardiology/American Heart Association (ACC/AHA) algorithm for detecting the presence of carotid plaque (CP) in RA patients. Methods Cross-sectional study. We recruited a total of 164 patients with RA diagnosis, according to the 2010 ACR/EULAR classification criteria, aged 40-75 years. Patients with a previous cardiovascular event were excluded. Cardiovascular risk was evaluated with the 2019 WHO algorithm for the Mexican population and the 2013 ACC/AHA cardiovascular algorithm. The results were multiplicated by 1.5, according to current guidelines. A carotid ultrasound was performed to all study subjects by a certified radiologist blinded to clinical information. Distribution was evaluated with the Kolmogorov-Smirnov test. Correlations were performed with the Spearman-rho coefficient (rho). A ROC-curve analysis was performed for both algorithms. The areas under the curve (AUC) of the algorithms were compared using the method of DeLong. Results The presence of CP was detected in 59 (36.0%) patients. Demographic characteristics are shown in Table 1. There was a large positive correlation between the WHO and the ACC/AHA algorithms (rho=0.880, p =&lt;0.001). Both algorithms showed significant discrimination for the presence of CP in RA patients, the WHO algorithm had an AUC 0.729 (95% CI 0.649-0.809, p =&lt;0.001) and the ACC/AHA algorithm had an AUC 0.687 (95% CI 0.604-0.770, p =&lt;0.001). However, there was a difference when comparing both AUC, which was higher with the WHO algorithm ( p =0.042) (Figure 1). Table 1. Demographic characteristics of RA patients Characteristics RA patients (n=164) Age, years, mean ± SD 55.82 ± 8.94 Women, n (%) 157 (95.73) T2DM, n (%) 27 (16.46) Hypertension, n (%) 53 (32.32) Dyslipidemia, n (%) 58 (35.36) Obesity, n (%) 56 (34.15) Active smoking, n (%) 15 (9.15) WHO algorithm, median (IQR) 4.5 (3.0-9.0) ACC/AHA algorithm, median (IQR) 3.75 (1.80-9.26) Carotid plaque, n (%) 59 (36.0) RA, rheumatoid arthritis; T2DM, type 2 diabetes mellitus; WHO, world health organization; ACC/AHA, American College of Cardiology/American Heart Association. Conclusion Our results showed that although both algorithms had significant discrimination for the presence of CP, the 2019 WHO algorithm had a better capacity for the detection of CP than the 2013 ACC/AHA algorithm, for this specific Hispanic RA population. This could be attributed to the fact that the WHO algorithm was designed for 21 different regions, including the Mexican population. References [1]Group WCRCW. World Health Organization cardiovascular disease risk charts: revised models to estimate risk in 21 global regions. Lancet Glob Health. 2019;7(10):e1332-e45. Disclosure of Interests None declared.